Services for mothers with mental illness

The outline of the services required for this area of psychiatry is slowly emerging. Its aims are prevention in those who are vulnerable, early and accurate diagnosis, and rapid effective intervention, with minimal disruption of family life. These aims require the following.

• A specialist multidisciplinary team This team can treat severe and intractable illness, train all staff, develop services, and conduct research, including treatment innovations.

• A community service Domiciliary assessment and home treatment are appropriate for these patients.

• Day care A day hospital can provide a full range of interventions—groups, play therapy, motherhood classes, anxiety management, occupational therapy, etc.—with minimal family disruption. The presence of mothers with similar disorders is a rich source of support. The children are cared for by nursery nurses in a crèche.

• Inpatient facilities Conjoint admission of mother and infant is greatly superior to the admission of the mother alone.(71) Wards dedicated to conjoint admission also have advantages over admission to a general psychiatric ward, although they are difficult to finance.

• An obstetric liaison service Apart from treating mental illness during pregnancy, this provides a prevention opportunity by detecting vulnerability during pregnancy.

• Links with other agencies providing services for mothers The social services have a key role. Social workers have the experience and resources for dealing with the practical difficulties of mothering, for example they can arrange home help and day nurseries. Their family centres fulfil a similar function to a mother-and-baby day hospital. In extremis, they can relieve the burden on the mother, and safeguard the child, by providing emergency foster care. Other agencies include the National Society for the Prevention of Cruelty to Children (in the United Kingdom), midwifery services, primary care teams, and child psychiatry services.

• A network of voluntary organizations These are independent organizations, but can have close cordial ties with the professional service. There is no one better suited to supporting a depressed mother than another mother who has suffered from a similar problem and is now well—she knows the stratagems or words of comfort that were helpful to her, and is a living proof of the hope of recovery.

• Medico-legal expertise Expert advice is often required in cases of child abuse or infanticide, and where a mother with mental illness is seeking custody of, or access to, her children.